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<a APPLICATION FOR PERMIT -' SAN JOAQUIN COUNTY PUBLIC HEALTH B> liVT ENVIRONMENTAL HEALTH DIVIS 1601 E. HAZELTON AVE. , PHONE (20� ��$ P O BOX 2009, STOCKTON, CA PERMIT EXPIRES 1 YEAR FROM `� g,RV CL3 {Complete in Triple M EvI�LHEALMOMON BORING DESTRUCTIO1 Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San a Joaquin County Public Health Services. Job Address 26500 Chri smisn .Road y Tracy y hot Size/Acreage owners Name Defense Depot Tracy Address 26500 Chri sman Road 41674 Christy Street Phone 209 832-9532 (� 6doL,f dor Ensco Environmental AddressEremont, CA 94538-3114 i� 464324 License Iva. Phone 415 659-0 04 �y CTYPE OF WELL/PUMP: NEW WELL q WELL REPLACEMENT ❑ DESTRUCTION�Out of Service Well ❑ '�/ SOIL BORING PUMP INSTALLATION ❑ SYSTEM REPAIR G OTHER © Monitoring Well t DISTANCE TO NEAREST: SEPTIC TANK ±fl0t. SEWER LINES 100_f_t— DISPOSAL FLD. NA PROP. LINE' NA SO tl ` k FOUNDATION NA AGRICULTURE WELL NQ OTHER WELL NA PITS/SUMPS Imo. 1 I INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS n Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation CH Dia. of Well Casing _NME C7 Domestic/Private ❑ Gravel Pack Ll Tracy Type of Casing NONE Specifications 3.4]�_Si �4 I'I Public Cl Other ! rl Delta Depth of Grout Seal - .15 ft Type of Grout B 1 I] I I Irrigation l c5—ftpprox. Depth I I Eastern Surface Seal Installed by Repair Work Done ❑ Type of Pump H,P. State Work Done Well Destruction ❑ Well Diameter Sealing Material &-Depth Tempnt 0 t•n 15 feet f Depth Filler Material & Depth [1ti Tk�E OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/ADDITION I I DESTRUCTION I l 1No septic system permitte ?V ` available within 200 lic sower is Installation will serve: Residence Commercial— Other Number of iivin �n- 9 Number of bedrooms Character of soil to a dept feet: SEPTIC TANK. Water table depth f1� D Type/M g pacity No. Compartments `} PKG. TREATMENT PLT. C7 "' Method of Disposal Distance to nearest: W Foundation Property Line LEACHING LINE ❑ No. & Len Total length/size lines 4 FILTER BED ❑ Di a to nearest: Well Foundation roperty Line SEEPAGE PITS I I Depth Size SUMPS Number C1 Distance to nearest: Well Foundation DIS SAL PONDS C) Property Line I hereby certify that I have prepared this application and that the work will be done in accordance with Sa rules and regulations of the San Joaquin County n Joaquin county ordinances, state laws, and Home owner or licensed agent's signature certifies the following: "I certify that in the performance of the work,for which this permit is issued, I shall not employ any person in such manner as to become subject to workman's compensation lawsof California.- Coritractor's hiring or sub-contracting signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall employ persona subject to workman's compensa- tion laws of California." The applicant m st tett for all required inspections. Complete drawing on reverse side, ' Signed X Title: Hydro 1 geo 1 og i s t Date: 3/15/90 FO AllK=-IJSE �j ! Application Accepted by Date i!/ —:! - Ar Pit or Grout Inspection by Date Final Inspection -72z2 Date � l� v Additional Comments: S S art S Applicant - Return all copies to: San Joaquin County Public Health __3 Services, Environmental Health Permit/Services 1601 E. Hazelton Ave., P 0 Box 2009, Stockton, CA 95201 FEE AMOUNT DUE AMOUNT REMITTED INFO CASH RECEIVED BY DATE PERMI7'NO. « EH 13-24IAEV.ii4Si3CJ.00 EH i4-26 b3 jS3